1. The blueprint or code that is used to construct other components of cells is called the:
a. DNA
b. Gene
c. Chromosome
d. Base
ANS: A
The DNA is the chemical inside the nucleus of the cell that has the genetic instructions for making living organisms. This can be compared to a blueprint or code that is used to construct other components of cells.

DIF: COG: Remembering REF: 244 OBJ: 1

2. Which statement regarding mutations is true?
a. Mutations in the DNA sequence occur on a regular basis.
b. Mutagens are a result of a mutation.
c. Environmental factors can be linked to many mutations.
d. Spontaneous mutations occur because of environmental exposure.
ANS: C
A large number of agents are known to cause mutations. These mutations are attributed to known environmental causes. DNA replication is very accurate, thus, mutations do not occur on a regular basis. Mutagens are the factors that cause mutations. Spontaneous mutations occur naturally during DNA replication.

DIF: COG: Understanding REF: 244 OBJ: 1

3. When a nurse learns more about the Human Genome Project to better counsel families about the process of genetic testing, the nurse is learning about:
a. Genetics
b. Genomics
c. Genes
d. Genetic susceptibility
ANS: B
Genomics refers to the study of individual genes to understand the structure of the genome, including the mapping of genes and sequencing the DNA.

DIF: COG: Applying REF: 242|245 OBJ: 1

4. An example of a multifactorial disorder is:
a. Measles
b. Hepatitis B
c. Eczema
d. Type I diabetes
ANS: D
Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are considered to be multifactorial.

DIF: COG: Applying REF: 246 OBJ: 1

5. The increasing knowledge about genetics and genomics will influence nursing practice by changing how:
a. Nurses collect and use health histories
b. Nursing students complete clinical experiences
c. Referrals to other disciplines are made
d. Ethical dilemmas are solved
ANS: A
Genetics and genomics will change future practice in several areas including: how students are educated, how nurses collect and use health histories, how nurses learn and apply innovative biotechnology, how prevention and health education is provided, administration of new therapies, and public health debates.

DIF: COG: Understanding REF: 242 OBJ: 2

6. The father of genetics is:
a. Charles Darwin
b. Gregor Mendel
c. James Watson
d. Francis Galton
ANS: B
Gregor Mendel is considered to be the father of genetics. Charles Darwin expounded on theories of evolution. Francis Galton performed family studies using twins to understand the influence of heredity on various human characteristics. James Watson was the co-discoverer of DNA.

DIF: COG: Remembering REF: 242 OBJ: 2

7. One of the main goals of the Human Genome Project was:
a. Providing physicians with a national database for information related to genetic disorders
b. Developing new medications that can be used in genetics research
c. Addressing ethical, legal, and social issues related to this research
d. Improving the ability to accurately test for genetic disorders
ANS: C
The goals of the Human Genome Project were to determine the sequences of the base pairs in human DNA; improve tools for data analysis; transfer related technologies to the private sector; and address the ethical, legal, and social issues that may arise.

DIF: COG: Understanding REF: 243 OBJ: 2

8. While collecting a medical history, a client reports having a family history positive for Huntingtons disease. However, the client states he does not want to have genetic testing performed. The nurse recognizes that one reason a client may refuse genetic testing is because of the:
a. Impact it may have on obtaining health insurance in the future
b. Legal consequences that may result
c. Inaccuracy of the results that are obtained
d. Decreased quality of life that may occur if the results are positive
ANS: D
Barriers to genetic testing are: some individuals do not have an insurance carrier that reimburses for genetic testing, a high-deductible insurance policy, and feelings that testing may decrease the quality of life and increase anxiety for the future if the results were positive. Others may also feel guilty about passing along a disease to children and grandchildren.

DIF: COG: Applying REF: 245 OBJ: 2

9. A nurse working in the 1970s would have applied genetic concepts by:
a. Providing genetic counseling to those with genetic disorders
b. Educating clients about using genetic testing for risk identification
c. Explaining the purposes of the Human Genome Project to clients
d. Facilitating referrals for specialized genetic services for clients
ANS: A
In the 1970s, nurses working in genetics provided genetic counseling to persons with genetic diseases or risk factors for such disorders. The other activities performed by the nurse did not occur until the 1990s.

DIF: COG: Applying REF: 248 OBJ: 2

10. Which question would be the most appropriate for the nurse to ask when eliciting information about a clients genetic history?
a. Have any of your family members ever completed genetic testing?
b. Do any of your family members have a genetic disorder?
c. What medical problems have your parents and grandparents experienced?
d. What environmental exposures have you had?
ANS: C
A clients family medical history is important to obtain in order to consider the clients potential risk for genetic diseases and disorders. The best way to obtain this information is to ask an open-ended question about past medical history of parents and grandparents.

DIF: COG: Analyzing REF: 246 OBJ: 3

11. The best response from a nurse when counseling a client who is considering purchasing a genetic testing kit from a vendor advertised on the Internet would be:
a. It is illegal to purchase genetic testing kits from Internet vendors.
b. It will be important to follow up with a health care provider after receiving your results.
c. Many times online vendors experience inaccuracies with their results.
d. Internet vendors use the latest technology to perform these tests.
ANS: B
The most important aspect of genetic testing is the counseling that occurs with the testing. Purchasing genetic testing kits on the Internet makes it easy for the public to access, but leaves a health care professional out of the testing process. Meeting with a health care professional is important to counsel a client about the implications and indications for such testing.

DIF: COG: Analyzing REF: 246 OBJ: 3

12. A nurse implements the principles of the Personalized Health Care Initiative in practice by:
a. Educating clients that multiple factors influence the development of disease
b. Counseling clients about the results of genetic testing
c. Lobbying for legislation to support genetic research
d. Protecting clients from discrimination based on the results of genetic testing
ANS: D
The goals of the Personal Health Care Initiative are to link clinical and genomic information to support personalized health care, protect individuals from discrimination-based or unauthorized use of genetic information, ensure the accuracy and clinical validity of genetic tests performed for medical application purposes, and develop common policies for access to genomic databases for federally-sponsored programs.

DIF: COG: Analyzing REF: 247 OBJ: 3

13. A nurse uses the Codes of Ethics developed by the International Council of Nurses and the American Nurses Association when:
a. Providing confidential genetic testing for a client
b. Advocating for the inclusion of genetic content in a nursing curriculum
c. Considering the pros and cons of an ethical dilemma
d. Becoming competent in genomics
ANS: A
The Codes of Ethics include in this mandate the right that people have to seek and receive genomic heath care that is nondiscriminatory, confidential, private, and that enables those served to make informed decisions.

DIF: COG: Analyzing REF: 249 OBJ: 3

14. A nurse is counseling a client who is considering having genetic testing completed to determine whether she is a carrier of the gene linked to Huntingtons disease. What is the first step the nurse would take when assessing this client?
a. Assess vital signs.
b. Assess family history of this disorder.
c. Assess clients past medical history.
d. Assess current medications.
ANS: B
Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing.

DIF: COG: Analyzing REF: 244 OBJ: 3

15. Which role of the nurse will be most important in the future practice of providing genomic nursing care?
a. Direct caregiver
b. Educator
c. Advocate
d. Referral agent
ANS: C
Although the nurse will use all of these roles when providing genomic nursing care, the most important role will be that of advocate. Nurses will increasingly provide guidance on policy discussions and ethical issues that relate to confidentiality, privacy, and commercialization. This is the nursing role of advocate.

DIF: COG: Evaluating REF: 250-251 OBJ: 3

16. A public health nurse is demonstrating one of the minimum competencies set forth by the National Coalition of Health Professional Education in Genetics (NCHPEG) when:
a. Organizing a meeting to discuss the care of cystic fibrosis clients
b. Making a referral to a genetics specialist
c. Advocating for legislation to support stem cell research
d. Educating a client about the results of genetic testing
ANS: B
The minimum competencies for health care professionals set forth by NCHPEG are: be able to examine competence of practice, understand the social and psychological implications of health-related genetic information, and know how and when to make referrals to a genetics professional. Making a referral is the only example that is described in these competencies.

DIF: COG: Analyzing REF: 248 OBJ: 4

17. A nurse applies genetic and genomic knowledge when completing a client assessment by:
a. Constructing a pedigree from a collected family history
b. Identifying a client who may benefit from genetic counseling
c. Referring a client to specialized genetic services
d. Incorporating knowledge of genomic risk factors
ANS: A
Constructing a pedigree from a collected family history demonstrates assessment in the nursing process. Identification is demonstrated by identifying a client who may benefit from genetic counseling. Referral is demonstrated by referring a client to specialized genetic services. Provision of education, care, and support is demonstrated by incorporating knowledge of genomic risk factors.

DIF: COG: Applying REF: 249 OBJ: 4

18. When a nurse considers that clients may not want to have genetic testing done because of the impact that it may have on future life decisions, the nurse is incorporating genetics/genomics into practice using:
a. Assessment
b. Identification
c. Referral
d. Provision of education, care, and support
ANS: B
One of the ways that a nurse uses identification is by identifying ethical, cultural, and societal issues related to genetic and genomic information and technologies. Assessment is not being performed here because the nurse is not assessing a particular clients needs or history. Referral is not taking place, nor is education, care, or support of a patient.

DIF: COG: Applying REF: 249 OBJ: 4

19. When a nurse understands the significant impact that genetic testing can have on an individual and family, the nurse is meeting a competency identified by the:
a. National Coalition of Health Professional Education in Genetics (NCHPEG)
b. Centers for Disease Control and Prevention
c. American Nurses Association
d. International Council of Nurses
ANS: A
The NCHPEG identifies one competency of health care professionals as being able to understand that health-related genetic information can have social and psychological implications for individuals and families.

DIF: COG: Applying REF: 248 OBJ: 4

20. Which statement would be most appropriate for the nurse to make when assisting a family in compiling a family health history?
a. When you have completed this history, it will not need to be updated.
b. Looking back at two generations of biological relatives will be sufficient.
c. The purpose of completing a family history is to decrease genetic susceptibility.
d. A family history is a useful tool when considering your future health risks.
ANS: D
A family history is a useful tool to help families know about their health risks and prevent disease in themselves and their close relatives. It is recommended that families develop a three generation history and update it on a regular basis. Completion of a family history will not decrease genetic susceptibility; rather it will make families more aware of what that susceptibility may be.

DIF: COG: Evaluating REF: 249 OBJ: 4

21. The Genetic Information Nondiscrimination Act (GINA):
a. Protects individuals from discrimination based on their genetic information
b. Allows health insurance companies to deny coverage for pre-existing conditions
c. States employers may collect genetic information from employees as needed
d. Requires employees to report genetic disorders to their employer
ANS: A
GINA was designed to prohibit the improper use of genetic information in health insurance and employment. It protects individuals from discrimination based on their genetic information, prevents denial of coverage based solely on genetic predisposition to disease, and limits disclosure of genetic information.

DIF: COG: Understanding REF: 247 OBJ: 5

22. A nurse is counseling a client whose genetic test results show a genetic susceptibility for breast cancer. The most appropriate statement by the nurse would be:
a. You should discuss hormone replacement therapy with your physician.
b. You are at an increased risk to develop breast cancer.
c. You should have a bilateral mastectomy as soon as possible.
d. You should tell all of your siblings and children to get tested.
ANS: B
Persons with a genetic susceptibility are at increased risk for developing the disease. Although the client may choose to have a bilateral mastectomy and recommend genetic testing to other family members, the most important thing to relay to the client is that having a genetic susceptibility does not mean that one will automatically have the disease.

DIF: COG: Analyzing REF: 249 OBJ: 5

MULTIPLE RESPONSE

1. According to the CDCs Genomic competencies for the public health workforce, all public health workers should be able to (select all that apply):
a. Demonstrate basic knowledge of the role that genomics play in disorders.
b. Make appropriate referrals to those with more genomic experience.
c. Counsel individuals about their genetic susceptibility for particular disorders.
d. Recommend appropriate genetic screening tests for clients.
ANS: A, B
The CDCs Genomic competencies for the public health workforce apply to all public health professionals. All public health workers should demonstrate basic knowledge and be able to make appropriate referrals. The other statements would not be true of competencies of all public health workers.

DIF: COG: Understanding REF: 247 OBJ: 4

2. When delivering safe and effective nursing care, the nurse must consider the significance of which factor(s) in the development of disease? Select all that apply.
a. Genetics
b. Lifestyle
c. Environment
d. Technology
ANS: A, B, C
The knowledge of human genetics can improve the safety, quality, and effectiveness of care for clients. It is important for nurses to understand the predisposition to disease as well as the impact of behavior and social conditions on overall community health and well-being. Many genetic disorders have an environmental link.

DIF: COG: Applying REF: 244|248 OBJ: 3

3. A nurse is counseling a client who has just learned that she is a carrier of the BRCA-2 gene. What are potential reactions by this client?
a. Feelings of guilt
b. Fear of loss of insurance coverage
c. Feelings of anxiety
d. Fear for children
ANS: A, C, D
Feelings of guilt, anxiety, and fear for future susceptibility for children are all potential reactions this client may have. The Genetic Information Nondiscrimination Act (GINA) protects clients from losing insurance benefits based upon genetic information.